Provider Demographics
NPI:1336162106
Name:KLUGMAN-RABB, JODI LIZA (MFT)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:LIZA
Last Name:KLUGMAN-RABB
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 TAMAL VISTA BLVD STE 290
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1159
Mailing Address - Country:US
Mailing Address - Phone:415-652-7644
Mailing Address - Fax:
Practice Address - Street 1:240 TAMAL VISTA BLVD STE 290
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1159
Practice Address - Country:US
Practice Address - Phone:415-652-7644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT40563106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist